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3 Health Expectancy

Description | Specific Indicators | Corresponding Mandatory Objectives | Corresponding National Indicators | Data Sources |  Alternative Data Sources | ICD Codes | Analysis Check List | Method of Calculation |  Basic Categories | Indicator Comments | Cross-References to Other Sections | References


Description

Health expectancy is life expectancy weighted or adjusted for some measure of health-related quality of life (HRQOL). The HRQOL measure used can be dichotomous, yielding such estimates as disability-free life expectancy (DFLE), categorical, as in estimates of disability-adjusted life expectancy (DALE) or continuous and utility-based, as in estimates of health-adjusted life expectancy (HALE).

 

Specific Indicators
  • Health-adjusted life expectancy – health expectancy calculated using a utility-based measure of HRQOL. In this case, the Health Utilities Index.
  • Disability-free life expectancy – health expectancy calculated using long-term disability as a measure of HRQOL.


Corresponding Mandatory Objectives

  • None
  
Corresponding National Indicators

 

Corresponding Indicator from Other Sources

  • The World Health Organization derives disability-adjusted life expectancy (DALYs) and disability-adjusted life expectancy (DALE) using a similar approach as is described above. For further discussion on differences see references (4,8).

Comparable Health Indicators
As a result of a Communiqué on Health issued by the First Ministers in September 2000, the health ministries from all provinces and territories, and the federal government have selected and reported on a set of comparable health indicators to the public. There are 14 areas for comparable health status and health system performance indicators reporting, organized under the three headings of health status, health outcomes and quality of service. This indicator is one of the comparable health indicators, also referred to as PIRC in Ontario (Performance Indicators Reporting Committee).
See Statistics Canada's web site:
http://www.statcan.ca/english/freepub/82-401-XIE/2002000/index.htm 
See Ontario Ministry of Health and Long-Term Care web site:
http://www.health.gov.on.ca/english/public/pub/ministry_reports/pirc_04/pirc_04.html 

Comparable Health Indicator: Healthy Canadians/Health adjusted life expectancy (HALE)
PIRC: How Healthy Are Ontarians Now?/Are Ontarians Living Longer in Better Health?


  
Data Sources (see Resources: Data Sources)

Death Rates
Numerator: Mortality Data

Original source: Ontario Office of Registrar General (ORG)
Distributed by:
1. Provincial Health Planning Database (PHPDB), Knowledge Management and Reporting Branch, Ontario MOHLTC
2. Health Planning System (HELPS), Public Health Branch, Ontario MOHLTC
Suggested citation (see Data Citation Notes):
1. Ontario Mortality Data [years], Provincial Health Planning Database (PHPDB) Extracted: [date], Knowledge Management and Reporting Branch, Ontario MOHLTC
2. Ontario Mortality Database [years], HELPS (Health Planning System) Release: [date], Public Health Branch, Ontario MOHLTC

Denominator: Population Estimates
Original source: Statistics Canada
Distributed by:
1. Provincial Health Planning Database (PHPDB), Knowledge Management and Reporting Branch, Ontario MOHLTC
2. Health Planning System (HELPS), Public Health Branch, Ontario MOHLTC
Suggested citation (see Data Citation Notes):
1. Population Estimates [years]*, Provincial Health Planning Database (PHPDB) Extracted: [date], Knowledge Management and Reporting Branch, Ontario MOHLTC
2. Population Estimates [years]*, HELPS (Health Planning System) Release: [date], Public Health Branch, Ontario MOHLTC
* Note: Use the total years of the estimates, including the most recent year, even if not all were used in the analysis. The years used in the analysis should be included in the report itself.

Health Utilities Index
Numerator & Denominator: 1990 Ontario Health Survey (OHS)
Original source:
Ontario MOHLTC
Distributed by:
Knowledge Management and Reporting Branch, Ontario MOHLTC
Suggested citation (see Data Citation Notes):
Ontario Health Survey 1990, Knowledge Management and Reporting Branch, Ontario MOHLTC

Numerator & Denominator: 1996/97 Ontario Health Survey (OHS)
Original source:
Statistics Canada
Distributed by:
1. Knowledge Management and Reporting Branch, Ontario MOHLTC
2. Statistics Canada
Suggested citation (see Data Citation Notes):
1. Ontario Health Survey 1996/97, Statistics Canada, Share File, Knowledge Management and Reporting Branch, Ontario MOHLTC
2. Ontario Health Survey 1996/97, Statistics Canada, Public Use Microdata File, Statistics Canada

Numerator & Denominator: Canadian Community Health Survey (CCHS)
Original source:
Statistics Canada
Distributed by:
1. Knowledge Management and Reporting Branch, Ontario MOHLTC
2. Statistics Canada
Suggested citation (see Data Citation Notes):
1. Canadian Community Health Survey [year], Statistics Canada, Share File, Knowledge Management and Reporting Branch, Ontario MOHLTC
2. Canadian Community Health Survey [year], Statistics Canada, Public Use Microdata File, Statistics Canada


Survey Questions/Variables


For Health Utilities Index used to calculate Health-adjusted Life Expectancy (HALE)
Ontario Health Survey 1990 Questions:

Responses used to calculate the Health Utilities Index:
Questions/Variables: Q35 to Q65

NPHS (all cycles) – 1996/97 Ontario Health Survey
Responses used to calculate the Health Utilities Index:
Questions HS-Q1 to HS-Q30

Variables:  NPHS 1994/95 (revised) 
NPHS/OHS 1996/97
NPHS 1998/99
NPHS 2000/01
hsc4_1 to hsc4_30
hsc6_1 to hsc6_30
hsc8_1 to hsc8_30
hsc0_1 to hsc0_30

Derived Health Utilities Index score:
Variables:  NPHS 1994/95 (original) 
NPHS 1994/95 (revised)
NPHS/OHS 1996/97
NPHS 1998/99
NPHS 2000/01
dvhst94
hsc4dhsi
hsc6dhsi
hsc8dhsi
hsc0dhsi

Note: The algorithm used to derived the HUI in the original versions of the 1994/95 and 1996/97 NPHS and 1996/97OHS was a provisional version of the HUI3. The finalized HUI3 algorithm was used beginning in 1998/99. It is important to know which version of the HUI is being used, as the scores can be quite different. Recalculations of the HUI for the earlier surveys are available from Statistics Canada.

Canadian Community Health Survey 2000/01 Questions:
Responses used to calculate the Health Utilities Index:
Questions UI-Q01 to UI-Q30
Variables:     CCHS 2000/01     huia_1 to huia_30

Derived Health Utilities Index score:
Variable:     CCHS 2000/01     huiadhsi

For measures of disability to use in the calculation of Disability-Free Life Expectancy (DFLE), see indicator Long-Term Disability and Activity Restriction.


Alternative Data Sources
Estimates for disability-free life expectancy for District Health Councils and Public Health Units are available from CIHI e-health indicators.


Analysis Check List

  • Before releasing and/or publishing these data, users should first determine the number of sampled respondents who contributed to the calculation of the estimate. If this unweighted number is less than 30, the weighted estimate should not be released regardless of the estimate’s coefficient of variation (C.V.). For unweighted estimates of 30 or more, users should determine the C.V. of the rounded weighted estimate and follow the guidelines below:
    • Acceptable (C.V. of 0.0 - 16.5) Weighted estimates can be considered for general unrestricted release. Requires no special notation.
    • Marginal (C.V. of 16.6 - 33.3) Weighted estimates can be considered for general unrestricted release but should be accompanied by a warning cautioning of high sampling variability.
    • Unacceptable (C.V. greater than 33.3) Statistics Canada recommends not releasing estimates of unacceptable quality. However, if the user chooses to do so then estimates should be flagged and the following warning should accompany the estimates: "The user is advised that . . .(specify the data) . . . do not meet Statistics Canada’s quality standards for this statistical program. Conclusions based on these data will be unreliable and most likely invalid". These data and any consequent findings should not be published. If the user chooses to publish these data or findings, then this disclaimer must be published with the data.
  • The release guidelines for the 1990 OHS are slightly different: No qualification (C.V. less than 16.6), Qualified estimate (C.V. of 16.6 – 25.0), Suppress estimate (C.V. greater than 25.0).


Method of Calculation

Spreadsheets to derive life expectancy and health expectancy estimates are available here. The method used for calculating life expectancy is Chiang’s (6) adapted for regional/local planning areas (7). A modified Sullivan method is used to calculate health expectancy by weighting the years of life lived according to a measure of health status, in this case either the HUI or prevalence of long-term disability. (8). Instructions are available with the spreadsheets. An analysis substitutes the age and sex-specific HUI or long-term disability prevalence estimate and mortality rates for a geographic area of interest into the spreadsheet. The spreadsheet then calculates life and health expectancy based on these estimates.


Basic Categories

  • Health expectancy at birth
  • Sex: male, female
  • Geographic areas for: CCHS - all 37 Public Health Units and 16 District Health Councils in Ontario; 1996/97 OHS - 23 health areas; 1990 OHS - all 42 Public Health Units and 32 District Health Councils that existed at the time.


Indicator Comments

  • Efforts to develop measures of population health that take into account both mortality and morbidity have resulted in the development of two major classes of summary measures of population health (SMPH): positive measures of health expectancy (1, 2), such as health-adjusted life expectancy (HALE), and measures of health gaps such as healthy life years (3) or disability-adjusted life years (DALYs).(4)
  • Health expectancy estimates overall life expectancy or life years lived adjusted according to the amount of time spent in less than perfect health or with disability.
  • Specific health expectancy measures are named based on the type of HRQOL that is used. The term health-adjusted life expectancy is used when health expectancy is derived using a utility-based measure such as the Health Utilities Index. The term disability-free life expectancy is used when health expectancy is derived using long-term disability as the measure of HRQOL.
  • Health expectancy measures can be used along with life expectancy to gauge whether there is a compression or expansion of morbidity. If health expectancy is increasing over time faster than life expectancy, there will be a compression of morbidity.(5)

Cross-References to Other Sections
  • None


References

  1. Mathers C, Robine J-M, editors. Health expectancy indicators: a review of the work of REVES to date. London: John Libbey and Company Ltd.; 1993.
  2. Robine JM, Romieu I, Cambois E. Health expectancy indicators. Bulletin of the World Health Organization 1999;77(2):181-5.
  3. Hyder AA, Rotllant G, Morrow RH. Measuring the burden of disease: Healthy life-years. Am J Public Health 1998;88(2):196-202.
  4. Murray C, Lopez AD, editors. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, Mass.: Published by the Harvard School of Public Health on behalf of the World Health Organization and the World Bank ; Distributed by Harvard University Press; 1996.
  5. Manuel D, Schultz S. Adding Life to Years and Years to Life: Life and Health Expectancy in Ontario. An ICES Atlas Update: Health Status Series. Toronto: ICES; 2001 January 2001. URL: http://www.ices.on.ca/webpage.cfm?site_id=1&org_id=31&morg_id=0&gsec_id=0&item_id=1280
  6. Chiang CL. The Life Table and its Applications. Malabar, Florida: Robert E. Krieger Publ. Co.; 1984.
  7. Manuel D, Goel V, Williams J. The derivation of life expectancy at the local level. Chronic Dis Can 1998;19(2):52-6. Available from: URL:
    http://www.phac-aspc.gc.ca/publicat/cdic-mcc/19-2/a_e.html.
  8. Sullivan D. A single index of mortality and morbidity. HSMHA Health Reports 1971;86(4):347-54.


Date of Last Revision: June 7, 2006 .

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